Browsing by Author "Marjamaa, Johan"
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Kuparinen, Xenia; Resendiz-Nieves, Julio; Kivisaari, Riku; Marjamaa, Johan; Abdirisak, Ahmed Haji Omar; Gröndahl, Joonatan; Vartiainen, Nuutti (2023)Background and objective: Spinal cord stimulation (SCS) is an effective treatment for chronic pain that does not respond to conservative treatment. Nonetheless, up to 38% of all implanted SCS electrodes are explanted, and while the risks involved in the surgical implantation of SCS paddle electrodes are well documented, there is scarce information about SCS explantations and their associated complications. We aimed to document the complication rate in SCS paddle electrode explantations and identify predisposing factors. Methods: We retrospectively reviewed the outcomes and the characteristics of all patients who underwent explantation of surgically implanted SCS paddle electrodes at the Helsinki University Hospital Department of Neurosurgery between February 2005 and October 2020. Results: 131 explantations were performed on 106 patients. The complication rate was 18.3% (24 operations). Major complications occurred during five operations (3.8%). No permanent neurological deficits were recorded. Smoking predisposed patients to postoperative complications (p = .023). On average, patients who suffered complications required a day longer hospitalisation (p = .011). Patients who had repeated explantations (three or more) suffered significantly more complications than patients who had only one or two operations (15.4% VS 62.5%, p = .005). Conclusion: Our results suggest that the explantation of the SCS paddle electrode is a relatively safe surgical procedure. Even though severe complications occurred, they were successfully managed. Repeated explantations should be treated cautiously as they seem to increase the complication rate considerably. Running Title: Explantation of SCS Paddle Electrodes Keywords: Complications, electrode explantation, electrode removal, paddle electrode, spinal cord stimulation
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Spontaneous Angiogram Negative Subarachnoid Hemorrhage : A Retrospective Single Center Cohort Study Achrén, Alexander; Raj, Rahul; Siironen, Jari; Laakso, Aki; Marjamaa, Johan (2021)Background: Spontaneous angiogram negative subarachnoid hemorrhage (SAH) is considered a benign illness with little of the aneurysmal SAH-related complications. We describe the clinical course, SAH-related complications and outcome of patients with angiogram negative SAH. Methods: We retrospectively reviewed all adult patients admitted to a neurosurgical intensive care unit during 2004–2018 due to spontaneous angiogram negative SAH. Our primary outcome was a dichotomized Glasgow Outcome Scale at three months. We assessed factors that associated with outcome using multivariable logistic regression analysis. Results: Of included 108 patients, 84% had a favorable outcome and mortality was 5% within oneyear. Median age was 58 years, 51% were female, and 93% had a low grade SAH (World Federation of Neurosurgical Societies grading I-III). The median number of angiograms performed per patient was two. Thirty per cent of patients showed radiological signs of acute hydrocephalus, 28% were acutely treated with an external ventricular drain, 13% received active vasospasm treatment and 17% received a permanent shunt. In the multivariable logistic regression model, only acute hydrocephalus associated with unfavorable outcome (odds ratio 4.05, 95% confidence interval 1.05–15.73). Two patients had a new bleeding episode. One of those patients had already suffered a spontaneous angiogram negative SAH prior to the current hospitalization. Conclusion: SAH-related complications such as hydrocephalus and vasospasm are common after angiogram negative SAH. Still, most patients had a favorable outcome. Only acute hydrocephalus was associated with unfavorable outcome. Our findings stress the importance of specialized neurointensive care for these patients.
Now showing items 1-2 of 2